Learning about the history of psychedelic therapy in the 1950s was an enlightening realisation of my own. Why, I wondered, had my profession turned its back on this apparently miraculous treatment? (Location 454)
As we go into the twenty-first century, psychiatry is desperately in need of a renaissance. (Location 514)
This dogma — that the psychotherapy patient ought to be stone cold sober when he or she approaches their session — has persisted. But I wonder how many of these apparent cornerstones of traditional psychotherapy are also legacies of a Christian narrative that tells us there is something inherently wrong or immoral about the intoxicated state. (Location 539)
The field of psychedelic medicine may be considered an offbeat subject to those who find it difficult to unhinge themselves from those stereotypical images of stoned hippies dancing at Woodstock. But to those cutting edge neuroscientists at the world’s leading research organisations, psychedelic drugs can no longer be ignored. They are becoming increasingly recognised as important tools to further our understanding of the brain. I would encourage any young and enthusiastic mental healthcare worker to familiarise themselves with research in this area. It could become an increasingly important part of the future of psychiatry.12 (Location 546)
generally, the LSD experience is essentially a mental experience. Having said that, mental experiences can have very physical implications and associations. (Location 572)
the sensory perceptions do not stay neatly in the modality that they ought to belong: sights can become sounds, for example, or a red flower can sound like a different tone of ringing bell than a blue flower. This phenomenon, synaesthesia, was employed by Owsley Stanley, The Grateful Dead’s sound engineer and LSD chemist, who could see the waves of sound flowing across the stage so knew best where to position the band’s speakers.3 (Location 580)
The uniting feature of these settings is that the user must feel safe, free to express themselves and contained. (Location 697)
when a drug such as LSD or psilocybin is taken under such carefully planned and judicious circumstances, there is every possibility that it will be one of the most important experiences of your life.11 (Location 708)
The totality of the psychedelic experience is a combination of pharmacological and psychological factors interacting together in a synergistic fashion; set and setting are essential components of the psychedelic experience that must be attended to in order to achieve a maximum positive response. (Location 711)
for the time being the most important message is Just Say Know To Drugs. (Location 721)
Obviously, we don’t advise people not to climb mountains because it is difficult or dangerous. We just caution them to do it with care. (Location 734)
who says psychedelic drugs are unnatural? And secondly, there is nothing easy about navigating an experience on 300 micrograms of LSD. Perhaps such critics are influenced by our Western world’s ingrained narrative that there is something inherently wrong or immoral about non-ordinary states of consciousness. I believe this narrative must be challenged. Why is playing golf or watching opera any more natural than eating fresh mushrooms one has just picked off a rainy Welsh hillside? (Location 737)
Close relatives of both tryptamine and phenethylamine are found in their natural states in high concentrations in our brains, which have lead some scholars to suggest the presence of endogenous psychedelic chemicals secreted by our brains under ordinary, apparently non-psychedelic, circumstances. For example, the common and immensely important neurotransmitter 5-hydroxytryptamine (also called serotonin or 5-HT) is the base molecule tryptamine plus an extra oxygen molecule in the fifth position of the benzene ring. The immensely potent psychedelic substance dimethlytryptamine (DMT) is simply the same tryptamine structure but with two extra carbons atoms instead of the oxygen. Both are extremely close to tryptamine structurally, but the effects on the brain between the two substances could not be more dramatic. (Location 767)
The theory is that these endogenous psychedelic drugs — particularly DMT — are released at times when we have naturally occurring intense, non-drug-induced experiences, such as religious, mystical or near death experiences. This is a fascinating possibility and intuitively it makes sense. Furthermore, the pineal gland is considered by many to be the site in the brain where the DMT is produced and released. Rick Strassman’s work on DMT provides more detail about these ideas, which have not yet been established by rigorous scientific validation but are certainly worthy of further research.17 (Location 773)
The compound has a plasma half life of around five hours and the experience lasts for between six and twelve hours, though some ‘afterglow’ effects can be felt for several days. The difference between the relatively short half-life and the lengthy intoxication itself suggests LSD may trigger a central psychological reaction that remains self-perpetuating long after the influence of the chemical itself has degraded. (Location 780)
Although the classical psychedelic drugs influence many major neurotransmitters, the main psychedelic effects of LSD relate to its role as a potent agonist at 5-HT2A receptors in the layer IV pyramidal cells of the cerebral cortex.18 The exact mode of action — how this effect causes the extraordinary mental experiences that occur — is poorly understood, though it is believed the effect is mediated through increasing glutamate release and associated excitation in that area. (Location 787)
Aldous Huxley, in his description of the effects of mescaline and LSD, talked of the so-called reducing valve hypothesis in which he proposed that psychedelics work by inhibiting the brain’s natural tendency to block out a large proportion of the actual perceptual stimuli that that floods into it.19 In other words, our brains act as valves and only present a small fraction of this material to our normal consciousness. As Huxley put it in The Doors of Perception: (Location 790)
From a physiological point of view, LSD is virtually inert. With hundreds of millions of people taking it worldwide consistently for the last 60 years, there have been no confirmed deaths from the physical effects of LSD. Herculean overdoses have been reported when people have accidentally taken hits in excess of 5000 times the normal dose, for example when mistakenly snorting a white powder assumed to be cocaine that turns out to be pure LSD crystals, but even under these circumstances physical reactions causing death have not been reported. (Location 849)
LSD is not addictive. Animal experiments confirm that it does not have anything like the abuse potential of drugs such as alcohol or cocaine. Rats in cages do not repeatedly self-administer themselves with LSD if given the opportunity to do so.24 Humans reflect the low dependence potential for LSD in the observed epidemiological use too. Many people have experimented with LSD a few times, usually in their late teens or early twenties. The majority will say it was a positive experience but ‘no thanks,’ they ‘don’t want to do it again’. Some people will choose to be longer-term users and repeat the experience, but again the pattern of usage is usually very infrequent. Indeed, a ‘regular user’ may say they take LSD no more than once a twice a year or even less, but say they find it a fulfilling and positive experience, something to be shared with close friends and family on a social occasion. For the vast majority of users, the classical psychedelics like LSD and psilocybin are not the sort of drug one uses slavishly every Saturday night. (Location 856)
when one looks at the relative risk profile against the massive pattern of usage LSD is a remarkably low risk drug. (Location 867)
Being caught and prosecuted for a drug offence is by far the most dangerous aspect of using LSD. It can completely ruin your life in a severity entirely out of proportion to the potential risks to your physical or mental health. (Location 870)
The drug was studied extensively by the medical profession in the 1950s and 1960s before becoming popular as a recreational drug. It was subsequently banned worldwide in 1966, which halted medical research overnight but did very little to stop it’s recreational use. All of these issues will be covered in more detail later on the book. (Location 874)
The active component in the mushroom, psilocybin, is readily converted to the active component psilocin in the body, which has its effect on the brain in a similar manner to LSD, that is as an agonist at 5-HT2A receptors. (Location 883)
Interestingly, yawning — a serotonin mediated response — is a recognised common feature of the mushroom experience that one does not get so readily with LSD. (Location 887)
In general, however, psilocybin is shorter acting that LSD; it’s effects can be observed for a period of five to eight hours. Commonly, people describe the experience as ‘slightly easier going’, ‘warmer’ or ‘more relaxed’ than LSD. Again, however, there are many confounding factors as to why people may say this — perhaps, for example, it is a reflection of more commonly taking psilocybin mushrooms in a natural setting when they are freshly picked. (Location 889)
Notably, Terence McKenna talked about always consuming greater than 5 grams of dried mushroom as the gold standard for a psilocybin-induced mystical experience. This quantity is echoed by contemporary writer and mushroom connoisseur, Dr Kilindi Iyi, who can be found cropping up at modern day psychedelic conventions, such as the Breaking Convention, at which he described his high-dose psilocybin internal shamanic journeys (‘alone in the darkness’) accompanied by his plea that ‘we need higher doses’. Iyi is convinced that messing around in the foothills of altered states of consciousness is never going to offer one the degrees of insight that can be achieved by taking oneself into the stratosphere, so to speak. And the only way to attain this higher trajectory is to push and push with the mushroom dose until one can go no further … and then go further still. He is not shy of giving the following advice: ‘If you feel worried and think “I may have taken too much” then that means you need to take more!’ This may sound like a rather reckless approach to some people, but I suppose when one is working with a drug with a virtually zero physical toxicity profile one can afford to push oneself with gigantic doses, assuming one feels psychologically robust enough to do so. (Location 898)
MDMA is not one of the classical psychedelics. Rather, it has been variously described as an empathogen or, by David Nichols of the Heffter Research Institute, an entactogen. There is an awful lot to say about MDMA. Not only is it a very widely used recreationally drug in the form of ecstasy, but it is also rising to the forefront as one of the psychedelic compounds proving to be the most useful as a tool to enhance psychotherapy. (Location 1026)
MDMA works by stimulating a massive release of stored serotonin from vesicles in the pre-synaptic membrane, which floods the synaptic gap and transmits the nerve impulse to the post-synaptic neurotransmitter. (Location 1035)
There are two major ways in which recreational ecstasy users can suffer acute (immediate) toxicity. The first is through hyperthermia.36 This may occur through prolonged physical exertion in a hot environment, combined with dehydration due to not consuming enough water. The euphoric effects of the drug may lead to the user failing to notice the usual thermostatic cues and continuing to dance vigorously despite their rising temperature. The effects of hyperthermia include liver and kidney failure and cerebral oedema. Further serious complications include rhabdomyolysis and disseminated intravascular coagulation. High temperature has also been demonstrated to further exacerbate the risk of longer-term neurotoxicity.37 The second cause of acute toxicity is ecstasy-induced hyponatreamia.38 In vulnerable individuals with a genetic predisposition for the condition, MDMA can cause an impairment of the kidney’s normal water homeostasis mechanism via an increase in arginine vasopressin (ADH) that can lead to excess water retention. When this is combined with the potential for excessive water consumption (as has sometimes occurred because users have been over-vigilant about the risks associated with dehydration), there can be associated decreased serum sodium, which in turn leads to nausea, weakness, fatigue, confusion, seizures and coma. In summary, then, when ecstasy is taken in uncontrolled circumstances, by naïve individuals, in extreme heat and with vigorous exercise, there may be problems associated with either drinking too much or too little water. (Location 1078)
In most of the current MDMA psychotherapy studies, the drug is only given once, twice, or a maximum of three times as part of a longer course of non-drug-assisted psychotherapy sessions, and there is always a gap of several weeks between the drug sessions. (Location 1098)
Given this data, it is clear that the media attention paid to the assumed dangerousness of MDMA is out of proportion. Even some of the scientific studies that have been historically cited a evidence for MDMA’s neurotoxicity have either been methodologically flawed or bear no resemblance to the manner in which the drug is used by human populations. (Location 1105)
For example, a study commissioned by the US government undertaken by George Ricaurte at Johns Hopkins University allegedly demonstrated severe neurotoxicity in primates given MDMA until it was discovered later that the bottles in the testing lab were incorrectly labelled and the animals were actually given the highly toxic drug methamphetamine instead of MDMA.42 Ricaurte’s paper in Science was subsequently retracted — though too late to have prevented the spread of an erroneous message about MDMA toxicity. (Location 1108)
Because of its wide and accepted medical uses, ketamine is a Class C drug (or Schedule 3 in the States), which is a very good illustration of the stupidly unfit-forpurpose classification schedule for controlled drugs. It has a much greater toxicity than the other safer psychedelic drugs described, all of which continue to languish in Class A and Schedule 1. But ours is not to wonder why nor question the wisdom of those in government who generously protect us with their drug laws. (Location 1211)
So they gave their patients LSD. But much to their surprise it did not frighten them out of their wits in quite the way the researchers had imagined. On the contrary, many of the patients quite enjoyed the experience, but crucially it did lead to abstinence from alcohol. Osmond and colleagues fine-tuned the process further, adding elements of supportive psychotherapy and, before long, were able to boast of abstinence rates of 50–90%, which far surpasses all other treatments for the condition before or since. (Location 1409)
terapia lsd psiquedélicos alcoholismo cita
I learned more about my brain and its possibilities in the five hours after taking these mushrooms than I had in the preceding fifteen years of studying and doing research in sychology. (Location 1506)
Famous for saying, ‘Acid was a bundle of solutions looking for a problem’, Hollingshead lived in Leary’s house, taught at Harvard and participated in the Concord Prison Experiment. (Location 1518)
The study stands out in psychedelic history partly because of the elaborate surroundings (it was conducted on Good Friday, 1962, at Boston University’s Marsh Chapel), partly because of Leary’s connection, and partly because it was one of the most beautifully designed double-blind placebo controlled psychedelic studies of its day — one of the very few from that that period, in fact, with such a high degree of scientific robustness; most other psychedelic studies of the time produced mere anecdotal data by comparison. Rick Doblin of MAPS reviewed this crucial moment in psychedelic research history many years later, in 1991, when he revisited the original participants of the Good Friday Experiment. They described how the insights and spiritual awareness gained that day have stayed with them throughout their lives as Christian ministers.28 But another reason why the Marsh Chapel experiment became so talked about was because it sparked a controversial debate, which still rages today, about the extent to which a drug can reliably mimic or, indeed, induce, a genuine spiritual experience. In order to study whether the drug had actually created a mystical experience, Pahnke used a structured set of criteria designed by W. T. Stace, which were agreed to accurately represent such an experience. Stace developed the scale for evaluation by conducting a review of multiple written examples of the characteristics of the (non-drug) mystical experience, identifying nine core criteria that were shared and essential to characterise a true mystical experience. These, which were translated by Bill Richards and Pahnke to directly describe the psychedelic experience, were: 1. Unity 2. Transcendence of space and time, 3. Deeply felt positive mood, 4. A sense of sacredness, 5. Objectivity and reality (real and known), 6. Paradoxicality (empty and full, alive and dead, microscopic and macroscopic) — ‘ both / and’. 7. Alleged ineffability (the realization that words can’t describe the experience), 8. Transiency (the experience is temporary) 9. Persisting positive changes in attitude and behaviour In his experiment, Pahnke gave half the group (ten subjects) an active placebo, nicotinic acid, which produces a mild tingling stimulation to fool the subjects into thinking they may have had the active drug. The other ten people received a 30mg dose of psilocybin — a large dose by any standards. However, despite the efforts to blind the experiment in this way, it became obvious within half an hour who had had which drug: members of the psilocybin group were lounging around the pews of the church in awe at the booming voice of the minister delivering the sermon; the other group members were feeling somewhat short-changed. The participants, all of whom already had a strong Christian faith and were studying theology as part of a path towards becoming ministers, were later required to complete a battery of tests that measured the quality of their experience. The outcome was a success… (Location 1537)
In the 1950s and 1960s, before LSD was banned, throughout the world tens of thousands of patients were treated with psychedelic or psycholytic therapy by the medical profession. When the use of LSD stayed within the medical context, before it became abused recreationally, the adverse results were low and success rates were generally good.36 Over 2000 papers were published on LSD during that period and psychedelic therapy was truly considered the next big thing in psychiatry. (Location 1623)
Despite the protestations of those therapists who were using it safely and effectively with their patients, by 1966 tens of millions of people had used the drug outside of the medical environment. Rather than listen to the views of many academic and spiritual leaders at the time, who proposed a system of control that would allow for the safe use of the drug, the authorities, in their wisdom, made LSD illegal. Suffice to say, this legislation did nothing to curb LSD’s recreational use — which continued to grow, alongside the illegal use of every other drug — but the move was very effective at halting practically all medical research. The doctors, unlike the unscrupulous hippies who had no qualms about taking a banned drug, simply couldn’t associate themselves with such a red-hot product. Consequently, medical licenses to use LSD experimentally became harder to get and many interested psychiatrists simply moved on to other projects, namely, those new antipsychotics that the burgeoning pharmaceutical industry were now pushing with vigour. Psychedelic research ground to a halt, not because it wasn’t safe or effective, but simply because of socio-political reasons, which, in my view, is terribly bad science and left a lot of patients who may have benefitted from its use wanting. (Location 1676)